COMSAE 2 questions with verified solutions, Exams of Nursing

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COMSAE 2

Sheehan Syndrome A rare condition that occurs secondary to pituitary ischemia and subsequent infarction following significant postpartum bleeding. This occurs due to the decreased perfusion of the pituitary during the final stages of pregnancy and labor process. This can also occur due to significant blood loss during labor, leading to hypoperfusion of the pituitary gland and subsequent infarction. This will in turn cause a global decrease in the hormones that are produced in the anterior pituitary. The production of ADH and oxytocin is not affected because both hormones are produced in the hypothalamus, and stored in the posterior pituitary gland. Boseman & Ambrisentan MOA They treat pulmonary hypertension by competitively antagonizing endothelin-1 receptors, thus, decreasing pulmonary vascular resistance. Inclusion Body Myositis Characterized by inflammation and endomysia infiltrates of CD8+ T cells and macrophages that focally surround and invade myofibrils. The presence of rimmed vacuoles is a characteristic feature. It is more common in males over the age of 50-years-old. It manifests as an insidious onset of proximal muscle weakness, often with associated distal muscle weakness. The distribution of weakness is variable, but unlike polymyositis and dermatomyositis, asymmetry is common. Early involvement of the knee extensors, ankle dorsiflexors, and wrist and finger flexors is characteristic. Weakness of the wrist and finger flexors is often greater than their extensor counterparts. Hence, loss of finger dexterity and grip strength may be a prominent symptom. It also commonly causes greater weakness in knee extension when compared with the hip flexors. Deep tendon reflexes may be impaired or absent if weakness is severe. Laboratory results reveal a normal to slightly elevated level of serum creatine kinase. Muscle biopsy is the gold standard for diagnosis.

Polymyalgia Rheumatica A disease of the elderly that causes proximal myalgias of the hip and shoulder girdles. The symptoms appear first in the shoulder girdle, and patients commonly complain of stiffness after prolonged inactivity. The shoulder and hip girdles can be painful and stiff, causing difficulty in rising from a chair or raising their arms over their shoulder. Patients also have morning stiffness that typically lasts for more than one hour. There is no muscle weakness, as compared to dermatomyositis and polymyositis. It is commonly associated with giant cell arteritis. Laboratory studies reveal an erythrocyte sedimentation rate (ESR) > 40 mm/h. Treatment is with prednisone. What is the genetic transmission of Duchenne & Becker Muscular Dystrophy? XLR 5% Sheep Blood added to? Blood agar usually contains 5% sheep blood and is used to determine hemolysis patterns of Streptococcus Eosin-methylene blue is added to? A staining agent used to visualize Escherichia coli that show up as a metallic sheen. Nystatin is added to help culture which organism?

Nystatin is a part of the VPN or Thayer-Martin agar designed to grow Neisseria gonorrhoeae. What 2 OMM techniques can be used to thin mucous secretions in a pt with Asthma? Asthma is the most common chronic disease in childhood and asthma symptoms include wheezing, shortness of breath, chest tightness and cough. Asthma involves hypersensitivity of the bronchi and lower airways to allergens, cold or other irritants. This results in inflammation, bronchospasm and mucous plugging. β-2-agonists help dilate the bronchioles but do not directly affect the sympathetic nerves which regulate secretions. Persistent asthma can drive the upper thoracic (particularly T1-T4) sympathetic nerves into a chronically active state. One particularly significant physiologic response of this is proliferation of goblet cells. These cells in the bronchial mucosa produce thick, tenacious secretions which are difficult to clear. Rib raising is one method of normalizing (in this case, decreasing) sympathetic tone to thin the secretions. Another useful method is the thoracic pump, which can be particularly helpful in normalizing lymphatic flow out of congested tissues. Sympathetic Vicerosomatics Isolated Tricuspid Stenosis MC from? The most common causes are due to carcinoid heart disease and right atrial myxoma. What is the MOA of an Aspirin Overdose? It causes the uncoupling of oxidative phosphorylation and thereby reduces the amount of ATP produced. Aspirin transports protons generated by the electron transport chain back into the mitochondrial matrix. This decreases the amount of protons available for ATP synthase to use for formation of ATP. As a result, there is an accumulation of carbon dioxide in the body. Which leads to a respiratory alkolosis which is then followed by a Metabolic acidosis to recompensate (Mixed)

What is the Antidote for Cyanide Poisoning? Amyl nitrite. Cyanide inhibits cytochrome oxidase enzyme in the electron transport chain within mitochondria. This causes depletion of ATP. Patients with cyanide poisoning present with elevated heart rates, drowsiness, and eventual coma and death. Alkpatonuria An AR disorder that results from deficient activity of the enzyme homogentisic oxidase. It results in elevated levels of homogentisic acid which forms a pigment that is deposited in connective tissue and joints throughout the body. It typically presents in the 3rd decade of life, with initial pigmentation occurring in the ear cartilage and sclera of the eyes. A dark pigment is also deposited in the large joints and the lumbosacral spine. This leads to early onset arthritis and can result in joint replacements at a younger age. The disorder is characterized by urine that is of a normal color initially, but turns a dark black color if left standing due to oxidation of the homogentisic acid. The diagnosis is confirmed by measurement of homogentisic acid in the urine. No effective therapy is available for alkaptonuria. Metachromatic Leukodystrophy An AR lysosomal storage disease that causes progressive demyelination of the central and peripheral nervous system. It is due to a deficiency in Arylsulfatase A. Common manifestations include regression of motor skills, gait abnormalities, ataxia, hypotonia, upper motor neuron signs, and peripheral neuropathy. The diagnosis is established by demonstrating deficient arylsulfatase A activity in leukocytes or elevated sulfatides McArdle Disease

An AR glycogen storage disease due to a deficiency in the enzyme myophosphorylase. Myophosphorylase is involved in the breakdown of glycogen to glucose in the muscles. McArdle disease usually presents in adolescence or early adulthood with fatigue, myalgias, muscle cramps, weakness, exercise intolerance, and myoglobinuria. These symptoms are brought on by exercise. An ischemic muscle forearm test would reveal a failure of the lactate levels to rise in venous blood after ischemic exercise. Some AD diseases Tuberous Sclerosis achondroplasia Huntington disease Marfan syndrome neurofibromatosis. Some AR diseases cystic fibrosis sickle cell anemia hemochromatosis glycogen storage diseases thalassemias albinism infantile polycystic kidney disease (ARPKD) XLR diseases Bruton's agammaglobulinemia Wiskott-Aldrich

G6PD deficiency Lesch-Nyhan syndrome Duchenne muscular dystrophy Hemophilia A and B. XLD diseases Rett Syndrome Carcinoid Tumor Flushing, diarrhea, and bronchospasm are the classic signs with elevated 5-hydroxyindoleacetic acid (5- HIAA), serotonin, and other vasoactive substances into systemic circulation. The symptoms do not usually occur unless there is metastasis to the liver due to the initial filtering of these substances by the liver from the venous circulation of the original location. The most common metastatic sites are the liver and lung. Most of these arise from small intestine or proximal colon, but can also arise from the appendix. Function of Astrocytes Help form the blood brain barrier (BBB), reactive gliosis to brain damage, metabolism of neurotransmitters (GABA, serotonin, and glutamate), and buffering potassium concentration. Microglia Phagocytes found in the central nervous system that respond to tissue damage. They arise embryologically from monocytes. These cells enter the nervous system by the third week of development with the blood vessels.

Tamoxifen A selective estrogen receptor modulator. It works as a competitive estrogen antagonist in breast tissue and is used to treat estrogen receptor-positive breast cancer. It acts as a partial agonist on the endometrium, resulting in an increased risk of endometrial hyperplasia, polyps, and cancer. Celiac Disease Most often presents between the ages of 10 and 40. It is a gluten-sensitive enteropathy caused by proteins in wheat, barley, and rye. It is associated with a number of autoimmune disorders, including type 1 diabetes mellitus and Hashimoto’s thyroiditis. Anti-endomysium IgA-antibodies and anti-tissue transglutaminase are highly sensitive and specific for diagnosis. The classic description of celiac disease includes the symptoms of malabsorption such as steatorrhea, weight loss, and fat-soluble vitamin deficiency. There is a characteristic presence of histologic changes of villous atrophy on small intestinal biopsy. The appropriate treatment is a gluten-free diet for life, and this results in complete resolution of symptoms for most individuals. Whipples Disease Caused by the gram-positive bacillus Tropheryma whipplei. It is another cause of malabsorption syndrome. Intestinal biopsy reveals clumps of Periodic Acid-Schiff macrophages in the lamina propria. Patients often present with migratory arthralgias of the large joints, along with weight loss, diarrhea, and abdominal pain. Treatment is with tetracycline. Chronic Kidney Disease Diabetes is the most common cause of kidney failure in the United States and affects the kidneys via non-enzymatic glycosylation of the glomerular basement membrane, which produces hyaline arteriolosclerosis of the efferent arterioles causing increased filtration and damage to the endothelial cells ultimately increasing vessel and tubular cell permeability. Hypertension also increases resistance and damages microvessels, which increase permeability to proteins. Patients usually present with signs of microalbuminuria, proteinuria, and polyuria. They can also complain of bone pain due to enhanced

osteoclastic activity in the bone. They eventually develop the inability for 1 alpha-hydroxylase that is located in the kidney proximal tubules to convert inactive vitamin D to active vitamin D (calcitriol). This leads to decreased absorption of both calcium as well as phosphorus. Patients will have an increased parathyroid hormone (PTH) level due to the hypocalcemia and hyperphosphatemia. Patients with chronic kidney disease also develop the inability to excrete phosphate through the urine so blood tests will reveal an elevated serum PTH, decreased serum calcium, but increased serum phosphate level. Pseudohypoparathyroidism (Albrights Hereditary Osteodystrophy) An AD condition involving the kidney's unresponsiveness to parathyroid hormone. Decreased serum levels of calcium, increased serum phosphate, and appropriately elevated PTH levels are seen on blood tests. Individuals with this condition usually have short stature, characteristically shortened fourth and fifth metacarpals, rounded facies, and, often, mild mental retardation. Curved rod that grows at 42 degrees celsius Campylobacter jejuni Rett Syndrome Deletion of the MECP2 gene on the X chromosome. The MECP2 gene is translated into methyl-CpG binding protein 2, which is responsible for regulating expression of other genes through methylation. It occurs almost exclusively in females and is proposed that males with the MECP2 deletion die in utero. Typically, affected children present at 1-4 years of age with regression of social interaction, inability to speak, and characteristic midline hand movements such as wringing or clapping. In early infancy, the signs are usually nonspecific, including hypotonia and lack of interaction. Later signs include seizures, rigidity, and loss of ambulation. Complications involve prolonged QT interval, osteopenia, gastroesophageal reflux, and delayed gastric emptying.

Thrombotic Thrombocytopenic Purpura (TTP) A blood disorder characterized by clotting in small blood vessels of the body, resulting in a low platelet count. In severe cases, the disease consists of a pentad of microangiopathic hemolytic anemia, thrombocytopenic purpura, neurologic abnormalities, fever, and renal disease. These pts have unusually large multimers of von Willebrand factor (vWF) in their plasma. They lack a plasma protease that is responsible for the breakdown of these ultra-large vWF multimers. This protease has been isolated and cloned and is designated ADAMTS13. Mostly seen in adults. The classic pentad for TTP is Fever, Anemia, Thrombocytopenia, Renal failure, and Neurological symptoms (mnemonic: FAT RN) Idioptahic Thrombocytopenia (ITP) The only abnormal finding is a low platelet count with increased bleeding time. It is due to anti-GpIIb/IIIa antibodies, which destroy peripheral platelets. These pts will NOT have anemia, acute kidney injury, or neurological manifestations Ligaments of the Spine Erector Spinae Muscles Reye Syndrome (RS) A rapidly progressive encephalopathy with hepatic dysfunction which occurs several days after recovery from a viral illness (e.g. chickenpox or influenza). Manifestations of Reye's syndrome include vomiting, confusion, seizures, and coma with laboratory studies revealing elevated aminotransferases, prothrombin time, ammonia, and metabolic acidosis.

ACL Injury The ACL is likely injured and often occurs in athletes after a twisting or hyperextension injury. It is common for the patient to report hearing a “pop.” The ACL is important in restricting anterior translation of the tibia on the femur. The ACL originates on the posterior aspect of the lateral femoral condyle and inserts on the anterior and medial aspect of the tibial plateau. The examination maneuver described above is a positive anterior drawer test or Lachman test. These tests are considered positive when the tibia translates forward on the femur to a greater degree in the injured knee than the normal knee. An ACL tear can be confirmed by MRI. Insertions of the Scalene mm Tacrolimus Tacrolimus ointment is an immunosuppressive agent indicated for atopic dermatitis. The mechanism of action is unknown, but it has been documented to inhibit T-cell activation. Intravenous and intramuscular tacrolimus is often used in transplant operations to prevent rejection of organs Epidural vs Subdural Hematoma The gynecomastia and spider telangiectasia of chronic liver failure are due to? Excess Estrogen Medullary Thyroid Cancer

Parafollicular cells are responsible for production of calcitonin, a hormone that decreases serum calcium levels. Calcitonin inhibits intestinal resorption of calcium, enhances deposition of bone, and increases calcium excretion by the kidneys. Neoplasm of these cells is referred to as medullary carcinoma. Symptoms include diarrhea, flushing, and symptoms of hypocalcemia—oral and acral paresthesias, tetany, hyperactive reflexes, and QT prolongation. A palpable nodule with or without regional lymphadenopathy would often be present. Graves Dz is what type of Hypersensitivity? Type 2 HS Irreversible vs Competitive inhibition Irreversible inhibition decreases Vmax, while competitive inhibition increases Km. Quick Facts About Sarcoidosis Elevated ACE levels is a marker. Bilateral hilar adenopathy, interstitial fibrosis, hypercalcemia, Bell’s palsy, and erythema nodosum are the common associations. CD Present on all T cells CD T cells and a small subset of B cells

CD

macrophages Erb-Duchenne Palsy Also known as "Waiter tip." This occurs when there is trauma to the neck causing a stretch of the superior roots of the brachial plexus (C5 & C6), often the result of shoulder dystocia (created when baby coming out of birth canal). The muscles innervated by these roots are subsequently weak, which are the abductors of the arm, the lateral rotators of the arm, the biceps, and often the extensors of the hand. Therefore, the arm hangs at the side, is medially rotated, and the forearm is pronated, often with a flexed wrist. Lewy Body Dementia The second most common type of degenerative dementia next to Alzheimer's disease. Common manifestations include progressive cognitive decline, detailed visual hallucinations, spontaneous Parkinsonian features, autonomic dysfunction (urinary incontinence or retention), and REM sleep disorders. Lewy body dementia has an associated defect in alpha-synuclein that would be evident upon a histologic study of the brain 3 drugs known to improve Survival in CHF Are ACE inhibitors, spironolactone, and metoprolol. For those with prior CHF with a reduced left ventricular ejection fraction, beta blocker therapy is implicated (carvedilol, metoprolol, or bisoprolol).

Fabry Disease XLR. This patient is presenting with acroparesthesias, the non-blanching reddish-blue capillary lesions known as angiokeratomas, telangiectasias of the groin and hip, and left ventricular hypertrophy. This dz is an X-linked recessive lysosomal storage disease due to a deficiency in the lysosomal enzyme α- galactosidase A. This leads to an accumulation of ceramide trihexoside in the lysosome of cells. Fabry disease may be present in male children as young as 9-years-old. Krabbe Disease An AR lysosomal storage disease that is due to a deficiency in β-galactocerebrosidase. It causes an accumulation of galactocerebroside in cells. Clinical features include peripheral neuropathy, developmental delay, and optic atrophy. Krabbe disease most commonly present within the first six months of life. Pathologically, periodic acid-Schiff-positive multinucleated globoid cells are present. Gaucher Disease An AR lysosomal storage disease that is due to a deficiency in glucocerebrosidase. It leads to an accumulation of glucocerebroside within the lysosomes of cells. It is most prevalent in individuals of Ashkenazi Jewish descent. It can present with diffuse bone pain and avascular necrosis of the femoral heads. Hepatosplenomegaly, anemia, and thrombocytopenia also occur. Histological examination will show the presence of Gaucher cells, which are lipid-laden macrophages that have the appearance of wrinkled tissue paper. Medications used to manage dystonia Many antipsychotic medications have the potential for causing extrapyramidal symptoms (EPS) due to their inhibition of dopamine receptors in the basal ganglia and nigrostriatal pathway, leading to an excessive cholinergic output. To counteract the loss of dopamine with acetylcholine excess, M3 receptor blockers (effective in 40% of patients) or levodopa/carbidopa are used to manage dystonia.

Medulloblastoma histology Homer-wright rosettes. Glioblastoma multiforme histology Histology shows central areas of necrosis with "pseudopalisading" pleomorphic tumor cells. What is the most common organism to cause parotitis? The most common organism involved in acute bacterial parotitis is Staphylococcus aureus. Anaerobic bacteria are less frequent causes of parotitis. Causes of elevated anion gap metabolic acidosis "MUDPILES:" Methanol Uremia Diabetic ketoacidosis Propylene glycol Iron tablets or Isoniazid

Lactic acidosis Ethylene glycol Salicylates. Acetazolamide A carbonic anhydrase inhibitor that is useful as a diuretic and for glaucoma. It prevents the reabsorption of bicarbonate, causing excessive loss of bicarbonate and sodium at the proximal tubules. Because of this, there is a compensatory increase in sodium reabsorption in the distal tubule. Chloride follows sodium as a pair in the distal tubule reabsorption, causing hyperchloremia. Therefore a hyperchloremic metabolic acidosis results. The elevated chloride results in a normal anion gap. Abduction of fingers Is accomplished by the dorsal interosseous muscles of the hand. These muscles are innervated by the deep branch of the ulnar nerve, which arises from the medial cord of the brachial plexus Adduction of the thumb Is accomplished by the adductor pollicis muscle of the hand. This muscle is innervated by the deep branch of the ulnar nerve, which arises from the medial cord of the brachial plexus. Pronation of the forearm

Is accomplished by the pronator teres and pronator quadratus muscles. The pronator teres is innervated by the median nerve, and the pronator quadratus is innervated by the anterior interosseus branch of the median nerve. The median nerve arises from both the lateral and medial cords. Deep inguinal Nodes The deep inguinal nodes directly drain the glans penis, clitoris, and afferent lymphatics from superficial nodes. Superficial Inguinal Nodes Directly drain cutaneous structures inferior to the umbilicus, excluding the external genitalia and anus Alpha-1-antitrypsin deficiency A codominant inherited disorder that results in early onset panacinar emphysema as well as cirrhosis of the liver. Patients typically present with signs and symptoms of COPD at an early age and may not even have a history of smoking. The distension of the abdomen along with the fluid wave points to signs of having ascites secondary to cirrhosis. AAT is an acute phase reactant that is synthesized in the liver and released from hepatocytes. The genetic defect in α-1 antitrypsin (AAT) deficiency alters the configuration of the AAT molecule, which prevents its release from hepatocytes. AAT normally inhibits elastic fiber breakdown around respiratory units caused by protease and elastase enzymes. An overabundance of elastase and trypsin in the lungs can result in the breakdown of alveolar surfactant proteins, increasing alveolar compliance. Furthermore, the inability of AAT to be released from hepatocytes results in an abnormal intracellular accumulation of AAT within the endoplasmic reticulum that leads to liver destruction. This hepatic destruction can eventually lead to liver cirrhosis and even hepatocellular carcinoma. AST, ALT, and bilirubin levels elevate above normal when hepatocyte damage occurs and bilirubin is backed up within the hepatic sinusoids. This can eventually lead to a jaundiced appearance. Bronchiectasis

A permanent dilation of the bronchi and bronchioles secondary to destruction of the cartilage and elastic tissue. This is caused by chronic necrotizing destruction from diagnoses such as cystic fibrosis, tuberculosis, bronchogenic carcinoma from asbestos exposure, and primary ciliary dyskinesia (aka Kartagener’s syndrome). The distal bronchi and bronchioles are most commonly affected and fill with pus. Patients will often present with productive cough of copious sputum (often cupfuls), massive hemoptysis, digital clubbing, and even cor pulmonale Heparin Has been documented to decrease and/or inhibit aldosterone levels. This drug potentiates the effect of anti-thrombin III, thereby inhibiting thrombin and Factor Xa working as an anti-coagulant. The patient is most likely suffering from the effects of aldosterone inhibition due to heparin administration Taste sensation to anterior tongue provided by? Facial N Raxibacumab A monoclonal antibody that binds and neutralizes the Bacillus anthracis toxin by binding to the free protective antigen component. It can be used as an adjunctive treatment with antibiotics (doxycycline or ciprofloxacin) in cases of inhalational anthrax. It is also used as a second-line treatment for prophylaxis of inhalational anthrax in patients at high risk of exposure. Eculizumab Is used in paroxysmal nocturnal hemoglobinuria to prevent formation of the membrane attack complex (MAC) on hemoglobin molecules. The monoclonal antibody binds to C5 and blocks cleavage of C5 into C5a and C5b, which is required for formation of MAC.

Natalizumab A monoclonal antibody that binds to integrin molecules involved in adhesion and migration of leukocytes into inflamed tissues. This drug has utility in inflammatory-mediated diseases such as Crohn’s disease and multiple sclerosis. Patients taking this should be tested for the JC-virus prior to and during treatment as it can increase their risk of developing progressive multifocal leukoencephalopathy. Rituximab A monoclonal antibody against the CD20 antigen on B cells. Binding of this drug results in cellular toxicity and death of B cells. This can be used in many autoimmune diseases to decrease the amount of B cells producing antibodies against the host. It is classically used in chronic lymphocytic leukemia, non- Hodgkin’s lymphoma, and rheumatoid arthritis Ulnar N Provides sensory innervation to the medial palm extending into the palmar aspect of the fifth digit and medial half of the fourth digit. It innervates all of the other intrinsic hand muscles that are not innervated by the median nerve. These include muscles of the hypothenar eminence (the abductor digiti minimi, flexor digiti minimi brevis, and opponens digiti minimi), the palmar and dorsal interossei, the third and fourth lumbricals, and the adductor pollicis muscles. Struma ovari A specialized or monodermal teratoma predominantly composed of mature thyroid tissue. The most common presentation is pelvic pain. Other findings include abdominal pain and symptoms of hyperthyroidism. Histologically, it can be microfollicular, macrofollicular, or oxyphil adenoma with or without papillary hyperplasia. Macrofollicular subtype contains large colloid-filled thyroid follicles. It can be benign or malignant.

Choriocarcinoma A malignancy of trophoblastic tissue. These tumors produce hCG, which can manifest as precocious puberty in young girls. Of most concern, choriocarcinoma can spread hematogenously to distant organs, especially to the lungs. Dysgerminoma A malignancy comparable to seminoma in males. There is a high association with Turner syndrome. These tumors produce hCG and/or LDH. Histologically, you will see sheets of uniform cells with centrally placed nuclei or “fried egg” appearance. Embryonal Carcinoma One of the most aggressive ovarian neoplasms. This is a germ cell tumor that forms nests and may form papillary or gland-like structures. They can produce AFP and/or hCG Endodermal Sinus Tumor An aggressive malignancy of ovaries and sacrococcygeal region of young children. Grossly, these tumors appear as yellow, friable, solid masses. Histologically, one should look for Schiller-Duval bodies, which resemble glomeruli. These tumors produce AFP Schizophrenia is due to defect in which neurotransmitter? Increased Dopamine

Depression is due to issue with which neurotransmitter(s)? Decreased levels of norepinephrine, serotonin, and dopamine Complete Molar Mole Vaginal bleeding is a common presentation in those with a hydatidiform mole. Additionally, this patient’s uterus is larger than expected according to the dates, no fetal heart tones are audible, and her β-hCG levels are markedly elevated. Complete moles are often associated with hCG levels > 100,000 mIU/mL (normal nonpregnant <5 mlU/mL and peak normal pregnancy level typically <100,000 mlU/mL). Women with a complete hydatidiform moles usually measure larger than dates, whereas women with partial hydatidiform moles measure smaller than dates. The ultrasound findings of a complete molar pregnancy include the absence of an embryo or fetus and no amniotic fluid. A central heterogeneous mass with numerous discrete anechoic spaces is usually present (snowstorm pattern) Pupillary Light Reflex It tests cranial nerves II and III. The afferent limb of this reflex is mediated by Optic N CN II. CN III, the oculomotor nerve, is responsible for pupillary constriction (Efferent limb) as it innervates the pupillary sphincter muscle. The optic nerve reaches the brainstem and connects bilaterally with the Edinger- Westphal nucleus, which controls parasympathetic output to the eye. These parasympathetic nerve fibers run along the oculomotor nerve and eventually synapse on the muscles of the iris. Parasympathetic stimulation will cause pupillary constriction. The oculomotor nerve innervates the levator palpebrae superioris, superior rectus, medial rectus, inferior rectus, and inferior oblique muscles. Corneal Reflex It tests CNs V and VII. The afferent limb of this reflex is carried by the trigeminal nerve, which is responsible for sensation to the face, specifically the ophthalmic branch V1 for the cornea. The efferent limb of the reflex is from CN VII. The facial nerve innervates the muscles of facial expression and is responsible for closure of the eye in this reflex. The facial nerve exits the skull through the stylomastoid foramen, located between the styloid and mastoid processes.

CN IX (Glossopharyngeal N) The gag reflex involves CN IX & X and helps prevent choking. CN IV carries general sensory innervations as well as taste sensation from the posterior 1/3 of the tongue. It also innervates the carotid bodies, carotid sinuses, and the parotid gland. Its only motor output is to the stylopharyngeus muscle. The efferent limb of the reflex is the vagus nerve,which innervates the pharyngeal constrictor muscles as well as some of the palate muscles. Absence of gag reflex could represent damage to the glossopharyngeal nerve, the vagus nerve, or brain death. The palatoglossus m Is the only muscle of the tongue NOT innervated by the hypoglossal nerve. It is innervated by the vagus nerve. The Stapedius m Located in the middle ear, and is much smaller than the tensor tympani. It is innervated by the facial nerve. What is the Innervation of the Tensor Tympani? Located in the middle ear, comes from the mandibular branch of the trigeminal nerve (V3). Its function is to dampen sound. Which hormonal Change can be used to help confirm menopause?

Menopause is the result of a decline in the sensitivity of the ovaries to stimulation by gonadotropins. This leads to elevated circulating levels of FSH and LH. Clinically, elevated FSH levels are used to indicate that menopause has occurred. Although both FSH and LH levels are elevated above pre-menopausal levels, FSH rises more significantly because it has a lower renal clearance compared to LH. What nerve innervated the pronator teres? Median N What is a common sacral finding in a post partum pt? Bilateral sacral flexion Klumpke's palsy Lower trunk injury involving the nerve roots C8-T1. It may be caused during a difficult breech delivery, by a cervical rib, or by abnormal insertion or spasm of the anterior and middle scalene muscles, which causes elevation of the first or second ribs. The injury causes a claw hand due to the involvement of the C8-T1 nerve roots, which innervate the ulnar nerve. These motor deficits include loss of adduction of the thumb, loss of abduction and adduction of metacarpophalangeal joints, loss of flexion at the metacarpophalangeal and extension of the interphalangeal joints, and weak flexion of proximal interphalangeal joints and distal interphalangeal joints. Von Hippel Lindau Dz Mneumonic H: hemangioblastoma I: increased risk of renal cell cancer (Clear cell) P: pheochromocytoma

P: pancreatic lesions (cyst, cystadenoma, cystadenocarcinoma) E: eye dysfunction (retinal hemangioblastoma), endolymphatic sac tumors L: liver, renal and pancreatic cysts 3 Gardner Syndrome Mneumonic Huntingtons dz is on chromosome? 4 Neurofibromatosis type 1 is on chromosome? 17 Bombesin A tumor marker for neuroblastoma. B-hCG A tumor marker for hydatidiform moles, choriocarcinomas, and gestational trophoblastic tumors.

HLA-DR2

Multiple sclerosis, hay fever, SLE, Goodpasture's Lead Poisoning This affects the enzymes of heme synthesis. Lead inhibits ferrochelatase, the last enzyme in the pathway of heme synthesis, as well as δ-aminolevulinic acid dehydratase (ALA-dehydratase), which catalyzes the second step of heme synthesis. Exposure to lead will lead to a microcytic anemia, gastrointestinal upset, kidney disease, and mental retardation. δ-aminolevulinic acid is formed by the combination of glycine and succinyl-CoA. This reaction, which is the first step in heme synthesis, is catalyzed by δ-aminolevulinic acid synthase (the rate-limiting step) along with the essential cofactor of vitamin B6 (pyridoxine). The formation of δ-aminolevulinic acid is inhibited by hemin. Vitamin B6 is a common cofactor for transaminase reaction. Adults with lead poisoning will present with a headache, memory loss, and symptoms of demyelination. Steady State Concentration It is an equilibrium that is achieved after a constant rate of infusion. It takes 4-5 half-lives for a drug to reach its steady state concentration, which is approximately 95%. Given the clearance (CL) and the volume of distribution (Vd) of the drug, its half-life can be calculated using the equation: t½= (0.693 x Vd)/CL Using this equation, you find that the t½ of the drug in question is 0.7 x 6.5/2 = 2.275 hours (2.25 when using 0.693 instead of 0.7). Since the steady state is reached after approximately 4 to 5 half-lives, the steady state concentration of this drug should be reached in 9-12 hours. Iodine 123 Uptake Grave’s disease causes increased serum T4, increased free T4, decreased serum TSH (because of negative feedback), and increased I-123 uptake (this is because the thyroid is working vigorously to make new T4, which requires iodine). In contrast, a patient taking excessive thyroid hormones will have a low I-123 uptake because the thyroid is not overactive (as in Grave’s disease).

Serotypes A, B, and C of Chlamydia trachomatis are responsible for For causing trachoma. Trachoma is a chronic keratoconjunctivitis that is commonly seen in areas of poor sanitation, with the highest incidence in parts of sub-Saharan Africa. Recurrent conjunctival reinfection causes prolonged inflammation that leads to conjunctival scarring. The clinical outcome of trachoma is vision impairment or blindness (worldwide, trachoma is the #1 cause of infectious blindness). Serotypes D-K of Chlamydia trachomatis are responsible for? For a variety of sexually transmitted infection sequelae, including non-gonococcal urethritis, mucopurulent cervicitis, salpingitis, neonatal conjunctivitis, and neonatal pneumonia. Serotypes L1, L2, and L3 of Chlamydia trachomatis are responsible for? For lymphogranuloma venereum, a sexually transmitted infection that most commonly presents with severely tender regional lymphadenopathy in the superficial and deep inguinal lymph nodes.